HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANKIED Permit Number:
BY
..... -----
. . . . . . . . . . . St Lucie COGMY
.
JAN 0 5 2018
Building Permit Application
Planning and Development Services . .......................
Building and Code Regulation Division
2800 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: SW,,1n1A1xj4 48-/
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Address:
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Legal Description: k i w r 4
K-a PropertyTax lD#: P- o Lot No.-?k.,ld
Site Plan Name: Block No.. S
Project Name: S A-A3 CLI j5hO I C;ej
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Additional work to be performed undert ispermi A al that apply:
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Mechanical Gas -Tank Gas Piping Shutters Windows/Doors
4ectric' -,Qlumbing Sprinklers Generator Roof
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Total Sq. Ft of Construction: I Lp Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
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Name: '
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Address: IA,) �eo /9(-/-)
Company:
City; State:0
Address:
Zip Code:,qQSff 2— Fax:
City: gr State:
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Phone No.3 ' - ffq 6
Zip Code jyqga Fax: 465 -/ 0 (0 3-
E-Mail: lm* Al J
Phone No
Fill in fee limple Title Holder on next page if different
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from the Owner listed above)
State ACounty License _J1
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY:
_ Not Applicable'
DESIGN /ENGINEER: _Not Applicable}"�iii
Name:
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Name:
Addres
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Address:
City:
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Sta ie:
City:
State:
Zip:
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Zip: Phone:
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FEE SIMPLE TITLE HOLDER: —
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
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Address:
City:
City:
Zip: Phone:
Zip: Phone'
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is grranting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your -Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,f, in all respects, pedform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County' Amendments.
The following building permit applications are exempt.from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wa�Is, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or rerordingvour Notilce of Commencement.
Sig a of wne Agent/ Lesse tractor Signature of Contractor/Lic%]ns%Holder
STATE OF FLORIDA STATE OF FLORIDAn'
COUNTY OF �B COUNTY OF
The for oing instrument was acknowledged before me The fo oing instrument was acknowledged before me
this V day of �� (' _ , 20� by this T day of Z) Pl , 20_0 by
(Name of person acknowledging) (Name of person acknowledging )
(tk4aaAire of Notary ublic- ate of Florida )
Personally Known OR Produced Ident fication
Type of Identification ,
Produced �,o1a° •?:ei% SHERRIFE111Y
�AY COMMISSION ,9 FF
Commission,No. s *1) EXPIRES: `tilarch 14.
BontledThru Budget Rotary
atu�e of Notalq-Pa15fiE- State of Florida )
Personally Known OR Produced,ldentification
Type of Identification
ission No. . *
— SHERRI FEHLIl.
*(=Y PAISSION 0 FF 100370
S: March 14, 2018
r Bonded Thru BudgetWery Seftes
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE t
0
COMPLETED
ev.